Open-sky capsulorrhexis in triple procedure: with or without trypan blue?

PURPOSE: To establish the beneficial effects of trypan blue 0.1% capsule staining in open-sky capsulorrhexis during triple procedure. METHODS: Patients who underwent penetrating keratoplasty (PK) with phacoemulsification and intraocular lens (IOL) implantation were divided into two groups. Group 1 consisted of 31 eyes of 26 patients with a mean age 64.4 +/- 6.9 years and anterior lens capsule was stained with trypan blue 0.1% to perform open-sky capsulorrhexis. In Group 2, capsulorhexis was performed without staining of the anterior capsule in 19 eyes of 17 patients with a mean age 60.6 +/- 5.3 years. The rates of complete capsulorrhexis and intra- and postoperative capsule-related complications were compared between the groups. RESULTS: The most common diagnosis before PK was corneal opacification in both groups. Open-sky capsulorrhexis was not completed in 3 eyes (9.6%) in Group 1 and in 9 eyes (47.3%) in Group 2. The rates of incomplete capsulorrhexis, posterior capsule tear, and transscleral fixation IOL implantation were higher in Group 2 (for each, p < 0.05). The diameters of capsulorrhexis were smaller than 4.5 mm in one eye in Group 1 and in two eyes in Group 2, and larger than 6.5 mm in two eyes in Group 1 and in three eyes in Group 2. Malposition of IOL, zonular dialysis, retinal detachment, and pupil capture were only observed in eyes in Group 2. In the follow-up period, there were no adverse reactions due to application of trypan blue in Group 1. CONCLUSIONS: Trypan blue staining of the anterior capsule during triple procedure helps the surgeon perform open-sky capsulorrhexis more easily and safely and in proper dimensions, provides positive effects on the other steps of the surgery, and decreases the rate of posterior capsule tear formation.

Vitreoretinal surgery for a subretinal hydatid cyst.

PURPOSE: To report the vitreoretinal surgery for management of a subretinal hydatid cyst. METHODS: Conventional pars plana vitrectomy was performed for the removal of a subretinal hydatid cyst and treatment of retinal detachment in the right eye (RE) of a 34-year-old woman. The cyst content was aspirated by a flute needle after retinotomy and cystotomy. The cyst wall was separated from overlying retina and removed. The retina was attached by liquid perfluorocarbon and silicone oil. Postoperatively, the patient was followed for 15 months. RESULTS: After vitreoretinal surgery, the retina RE was attached and recurrence of hydatid disease was not seen in vitreous cavity or subretinal space during the follow-up period. Visual acuity increased from counting fingers to 20/63 at the end of the follow-up time. CONCLUSION: A subretinal hydatid cyst that causes retinal detachment may be treated effectively with vitreoretinal surgery.

Treatment of trichiasis with argon laser.

PURPOSE: In this prospective study, argon laser photocoagulation was used to eliminate misdirected cilia. The cases were followed up to see the results and recurrences with this treatment. METHODS: 60 eyelids of 45 patients with trichiasis were treated with the argon laser. After topical anesthesia a blue-green argon laser was used with 1 watt power, for 0.20 seconds, with 100 micrometer beam diameter. The beam was directed coaxially to the lash follicle to create a 2-3 mm crater and vaporization was observed. After crater formation, the laser parameters were changed to 1.2 watt power, for 0.20 seconds, with 200 micrometer beam diameter, to destroy residual follicular tissue. Up to five lashes were treated in one session. At the end of each session an antibiotic ointment was used t.i.d. for a week. RESULTS: Patients have been followed for 4-12 months (mean 6 months). Recurrences have been seen in 15 of 60 eyelids (25%). Laser treatment has been used with the same protocol for the cases with recurrence and results have been successful in eight of them. Postoperatively severe pain, hemorrhage, scar formation, neovascularization of lid margin, or infection were not seen in any patient. In three cases mild hypopigmentation and in three other cases mild lid notching were observed. CONCLUSIONS: Argon laser lash ablation can be done as an effective office procedure with topical anesthesia. The advantages include low recurrence and complication rates in carefully selected patients and minimal postoperative discomfort.

Cerebellar astrocytoma presenting with acute esotropia in a 5 year-old girl. Case report.

We encountered a 5-year-old girl with acute onset of alternating, comitant esotropia in the absence of diplopia and other neurologic findings. She did not have any refractive error and seen bilateral papilledemas in fundus examination, magnetic resonance imaging (MRI) of the head was performed. A large cerebellar astrocytoma and moderate hydrocephalus was identified and successfully resected. The onset of comitant esotropia in a child can be the first sign of a cerebellar tumor without any other neurologic signs and symptoms.